Approximately 50% of prescription medications are not taken as directed. The Institute of Medicine and others have highlighted the importance of improving prescription drug management in the United States, particularly among at-risk populations, including patients with low health literacy or limited English proficiency. Incorporating illustrations into medication instructions is a promising approach to help patients better understand and adhere to their medical therapy. PictureRx is an innovative, evidence-based, internet platform for educating patients about their medications. It generates illustrated daily medication schedules that depict what medications the patient should take at each time of day and the purpose of each medication. We were funded to adapt PictureRx to meet the needs of the Latino community through a Small Business Innovation Research grant, "PictureRx: An Intervention to Reduce Latino Health Disparities" (1 R43 MD004048-01). This scope of work includes conducting focus groups and interviews with Latino patients, health care providers, and an advisory group of national experts;adapting PictureRx based on this input;and performing a small randomized controlled trial to evaluate its effect on patients'understanding of their medication regimen. This competitive revision is submitted in response to Notice NOT-OD-10-034 (NIH Announces the Availability of Recovery Act Funds for Competitive Revision Applications for Small Business Innovation Research and Small Business Transfer Technology Research Grants (R43/R44 and R41/R42) through the NIH Basic Behavioral and Social Science Opportunity Network (OppNet)). We propose to expand the scope of the funded R43 by performing additional basic behavioral science research on icons that illustrate the purpose of each medication. We currently have a set of more than 50 locally-developed icons that depict the drug indication. We will use an iterative design process to refine this set of icons, engaging patient focus groups as well as experts in the fields of cognitive psychology and human factors, who have agreed to serve as consultants. We will then perform computer-based experiments to assess the effect of the icons on participants'comprehension, answer time, recall, preferences, and satisfaction with medication instructions. Hierarchical regression models will allow us to determine the effect of patient characteristics, such as health literacy, inference ability, working memory, and processing speed, on patients'comprehension of icons and recall of medication instructions. Results of this investigation will provide important foundational knowledge on the use of icons in medication instructions, and will also form the basis for subsequent applied research in this area. Moreover, the findings will be immediately translated into practice through the small business applicant and PictureRx platform. PUBLIC HEALTH RELEVANCE: The Institute of Medicine, American College of Physicians, and National Council on Patient Education and Information have highlighted the importance of improving prescription drug management in the United States, particularly among at-risk populations, including patients with low health literacy or limited English proficiency. This proposal seeks to develop and test a set of icons to help patients better understand the purpose of common medications. The proposed research will provide important foundational knowledge on the use of icons in medication instructions, and it facilitate subsequent applied research in this area.